DBT is a well-established treatment for adults with BPD, with more than 7 randomized controlled trials (RCTs).23,24 To date no RCTs of DBT-A have been published. However, DBT-A has been examined in several open trials and quasiexperimental designs, with encouraging findings. Rathus and Miller21 conducted the initial validity study, comparing DBT with TAU in a nonrandomized study of 111 outpatient adolescents with BPD features, including current suicidal ideation or parasuicidal behavior. Adolescents who received DBT were significantly more likely to complete treatment and had fewer psychiatric hospitalizations (0% vs 13%). There were no significant differences in parasuicidal behaviors, although it is important to note that those with parasuicidal behavior were specifically recruited to the DBT treatment; differences in suicide attempt (1 vs 7) were nonsignificant.

Several smaller pilot studies of nonrandomized adolescents have been conducted using pre-post designs. They compared DBT-A or elements of DBT-A with TAU. Adolescents with nonsuicidal self-injury and other BPD features were treated with DBT or TAU in residential, hospital, and outpatient clinic settings. In each case, adolescents who received DBT evidenced greater reduction of symptoms, such as mood and self-injurious behavior, and evidenced improved relationships and overall functioning.23,25 However, the DBT-A approach awaits randomized controlled trial data, and for this reason, it cannot be designated well-established for adolescents at this time.

Summary

Despite the high prevalence of depression among youths, there are empirically supported treatments that have been shown to reduce depressogenic symptoms, including the 3 therapies outlined in this article. When deciding which treatment to employ, the clinical needs of the youth, such as cognitive capabilities, behavioral issues, interpersonal strengths and weaknesses, and suicidality level, should be taken into account.

Psychotherapy Training Resources

Cognitive-behavioral therapy

•Association for Behavioral and Cognitive Therapies: training and certification programs can be found on the ABCT Web site: www.abct.org

•Behavioral Tech, LLC: development of a certification process is under way; currently the highest level is Intensive Training (10-day workshop) requiring participants to register as a DBT Team of 4 or more persons (teams can be loosely defined and may not practice in the same setting): http://behavioraltech.org/training

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